Summary: In a 20-week double-blind trial in type 2 diabetes with peripheral neuropathy, adding empagliflozin improved glucose control, kidney filtration, the neuropathy symptom score, and nerve conduction velocity, although nerve amplitude and the clinical examination score did not significantly change.
PICO Summary
| Element | Detail |
|---|---|
| Population | 50 patients with type 2 diabetes and neuropathy confirmed by the Michigan Neuropathy Screening Instrument; 20-week double-blind RCT, Iran. |
| Intervention | Empagliflozin 10 mg daily added to existing regimen. |
| Comparison | Existing regimen plus placebo. |
| Outcome | The empagliflozin group had significant reductions in HbA1c and fasting glucose, lower serum creatinine, higher eGFR, an improved MNSI symptom (oral) score, faster nerve conduction velocity, and reduced latency. The clinical examination score and nerve amplitude did not differ significantly between groups. |
Empagliflozin add-on for diabetic neuropathy
RCT · type 2 diabetes with neuropathy · 20 weeks
Adding empagliflozin improved the patient-reported neuropathy symptom score and nerve conduction velocity alongside better glucose and kidney measures, but the clinical exam score and nerve amplitude were unchanged over 20 weeks.
Expert Commentary
This is an interesting early trial probing whether an SGLT2 inhibitor offers neuroprotection beyond glucose lowering, a genuinely important question given how few disease-modifying options exist for diabetic neuropathy. The encouraging element is the objective one: an improvement in nerve conduction velocity and latency points to a change in nerve physiology rather than mere symptom masking, and the parallel gains in glucose control and kidney function are mechanistically coherent, since both reduced glucotoxicity and reduced uraemic burden could plausibly benefit peripheral nerves. The honest reading, however, is mixed rather than uniformly positive, because amplitude, which reflects the number of functioning nerve fibres, and the clinical examination score did not significantly improve, suggesting any benefit over twenty weeks is partial and may reflect function more than structural recovery. The small sample of 50 and short duration further limit conclusions. Can I use this with my patients? As supportive context rather than a new indication. For diabetic patients who already warrant an SGLT2 inhibitor for cardiorenal reasons, this is a welcome possible bonus for nerve function, but I would not start empagliflozin specifically to treat neuropathy on this evidence, and would keep glycaemic control, foot care, and symptomatic therapy central.
References
Vafaeinasab M, Mirzaei Malekabad F, Khatibi A, Ghadiri-Anari A, Zare Bidaki M, Azizi R. The comparison of the effect of adding empagliflozin to the medication regimen on peripheral neuropathy in patients with type II diabetes: a double blind randomised clinical trial. Endocrinol Diabetes Metab. 2025;8(6):e70128. doi:10.1002/edm2.70128